HomeMy WebLinkAboutDRIVEWAY-CONNECTION PERMITt 12-0M
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION BSO-040.18
DRIVEWAY/CONNECTION PERMIT SCANNED SYSTEMS PLANNING
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FOR ALL CATEGORIES BY Page 1of3
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PARTI: PERMIT INFORMATION
Application Number. 1 3 h-�4 u w tl l A
Permit Category: 19 Access Classification:
Project: ()rpLl / h/ S idle ZTl—
Permittee: J /
Section/Mile Post: IJ- JO State Road: fO�J
Section/Mile Post: State Road:
PART 2: PERMITTEE INFORMATION
Permittee Name: Carroll and Janet Collins
Permittee Mailing Address: PO Box 4114
City, State, Zip: Fort Pierce FL 349484114
Telephone: 772-461-2245
Engineer/Consultant/or Project Manager: Culpepper & Terpening Inc
Engineer responsible for, construction inspection: Stefan K. Matthes 38723
NAME P.E. #
Mailing Address: 2980 South 2e St.
City, State, Zip: Fort Pierce FL 34981
Telephone: 772-464-3537 Mobile Phone:
r— PART 3: PERMIT APPROVAL
The above application has been reviewed and is hereby approved subject to all Provisions as attached.
Permit Number: 9 0
Department of Transportation
Signature: '/C� Title: PAUL BRE��^
Permit managcr
Department Representative's Name:
Temporary Permit ❑ YES [0/NO (If temporary, this permit is only valid for 6 months)
Special provisions attached: m YES ❑ NO
Date of Issuance: ,[� 9 —
If this is a normal (non -temporary) permit it authorizes construction for one year from the date of issuance. This can only
be extended by the Department as specific in 14-96.007(6).
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